How to Reduce Pressure Injuries in the ICU by More Than 10%

Memorial Hospital at Gulfport, Gulfport, Miss.
Christina Lehman, RN, BSN, CWOCN, CFCN; Angela Ladner, RN, BSN, CWON; and Karen Egli, BA, RN, CWCN

Purpose

Determine whether intensive care unit (ICU) patients require a more substantial mattress than the general patient population.

Background

A level 2 trauma center in the Southeastern U.S. purchased new mattresses for their facility with a “one size fts all” approach. The chosen surface was an alternating pressure redistribution surface with a foam overlay. Two years following the purchase, the pressure injury (PI) rates in the ICUs accounted for approximately 55% of the total hospital-acquired pressure injuries (HAPIs). ICU patients are a special population and at a high risk for PIs. Incidence rates for an ICU may be as high as 38%1 , demonstrating that ICUs warrant special concern.

Methods

The hospital chose to trial several products against their facility-owned surface (Control Bed A). A static low air loss (LAL) surface was chosen as Control Bed B and an alternating pressure LAL surface as Control Bed C. The trial entailed monitoring 112 ICU patients during two consecutive 30- day periods. Data was collected on length of stay, daily skin assessments, Braden Scale2 scores, and patient height and weight.

Outcome

During the trial period, a total of 12 PIs developed: three PIs on Control Bed A (hospital owned), nine on Control Bed B, and zero on Control Bed C.

Conclusion

Control Bed C, the surface with LAL and alternation therapy, proved more effective in reducing and preventing HAPIs in the ICUs. The facility elected to replace all 26 of its ICU beds with the alternating pressure LAL surface in order to reduce the HAPI rate in these high-acuity units. In the eight months following, the ICUs accounted for 40% of the total HAPIs—a reduction of 11%.

Quarterly Chart Showing Total ICU Hospital-Acquired Pressure Injuries Decreasing

About the Authors

Christina Lehman, RN, BSN, CWOCN, CFCN
Christina is a CWOCN at Gulf Coast Veterans Health Care System in Biloxi, Miss. She previously worked as a WOCN at Memorial Hospital in Gulfport, Miss.

Angela Ladner, RN, BSN, CWON
Angela is a CWON at Memorial Hospital at Gulfport, Miss. She has provided wound care, ostomy care, education, and hyperbaric therapy across inpatient and outpatient settings for 13 years.

Karen Egli, BA, RN, CWCN
Karen is a Clinical Liaison for Sizewise, a registered nurse, a certifed wound care nurse, and a member of the National Pressure Ulcer Advisory Panel’s Corporate Advisory Panel.

Angela Ladner and Christina Lehman
References:
  1. National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacifc Pressure Injury Alliance Prevention and Treatment of Pressure Ulcers: Clinical Practice Guidelines. Emily Haesler (Ed.). Cambridge Media: Osborne Park, Western Australia; 2014.
  2. Bergstrom N, Braden, BJ, Laguzza, A, Holman, V. The Braden Scale for Predicting Pressure Sore Risk. Nursing Research 1987; 36(4): 205-210.

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